Organization
CANTON ORTHOTIC LABORATORY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN THOMAS SIMKO LO (PRESIDENT/LICENSED ORTHOTIST)
(330) 454-2081
Entity
Organization
Contact information
Practice address
811 12TH ST NW, CANTON, OH 44703-1927
(330) 454-2081
(330) 454-9568
Mailing address
811 12TH ST NW, CANTON, OH 44703-1927
(330) 454-2081
(330) 454-9568
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
OH
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000155415
ANTHEM PROVIDER NUMBER
OH
05
—
0291143
—
OH
Enumeration date
06/01/2005
Last updated
08/22/2020
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